Seeking an experienced Compliance Auditor for a direct hire opportunity working for a Health Insurance Company in the Woodland Hills area! Position Purpose: Perform operational and compliance risk based audits for the health plan. Qualification/Skills: -Bachelor's degree in, Business, Accounting, Finance, Healthcare related field or equivalent experience -2+ years of compliance experience, preferably with State or Federal managed care programs Location: Woodland Hills, CA Hours: Mon-Fri 8am-5pm Salary: DOE
-Develop schedule and perform health plan audits and specialty care company (subcontractor) audits
-Evaluate processes and performance through audits for scalability, effectiveness, and risk mitigation
-Provide written audit documentation regarding state and/or federal managed care programs and process audit observations
-Review and analyze responses to audit observations and findings and facilitate corrective action plans
-Facilitate Health Plan and specialty care company (subcontractor) compliance through corrective action process.
- Identify, develop and implement corrective actions and training materials to improve program performance based on audit outcomes
-Provide education and training to internal and external entities as needed on programs, compliance, and fraud, waste and abuse
-Serve as a resource related to the health plan and specialty care company (subcontractor) programs
- Compliance (2 years of experience is required)
- Managed Care (2 years of experience is required)
- Health Plan Audits
- Years of experience: 3 years
- Experience level:Experienced
Working hours: 8 AM - 5 PM
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